Lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum.

We describe a rare case of lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum. This patient presented with a 12-month history of severe right leg pain and intermittent claudication. A computed tomography scan was performed, revealing a large calcified mass on the ligamentum flavum at the right-hand side of the lumbar spinal canal. We performed a laminotomy at the L4/5 level with resection of the calcified mass from the ligamentum flavum. The findings of various analyses suggested that the calcified mass consisted mostly of Ca3(PO4)2 and calcium phosphate intermixed with protein and water. The calcified mass in the ligamentum flavum was causing lumbar spinal stenosis. Surgical decompression by resection of the mass was effective in this patient. The calcified material was composed mainly of elements derived from calcium phosphate. Degenerative changes in the ligamentum flavum of the lumbar spine may have been involved in the production of this calcified mass.

Adjacent segment disease following expansive lumbar laminoplasty.

BACKGROUND CONTEXT: We developed the technique of expansive lumbar laminoplasty in 1981. In the procedure of laminoplasty, the spinal canal is decompressed by rotatory elevation of the laminae, and bone grafts from the spinous process and posterior iliac bone are placed on the surface of the operated laminae. Therefore, adjacent segment disease due to mechanical stress could be anticipated in the long-term follow-up. PURPOSE: To investigate the incidence of symptomatic adjacent segment disease after expansive lumbar laminoplasty, to identify the factors which are related to the development of this disease, and to discuss the treatment of this postoperative problem. STUDY DESIGN/SETTING: This is a retrospective cohort study. PATIENT SAMPLE: Seventy-one patients (53 men and 18 women with a mean age of 55.7 years) underwent expansive lumbar laminoplasty for the treatment of spinal stenosis. The average length of follow-up was 5.4 years with a range of 2 to 13 years. OUTCOME MEASURES: Follow-up evaluation was primarily by means of clinical visits. METHODS: The incidence of adjacent segment disease which resulted in the deterioration of Japanese Orthopaedic Association score was analyzed. The diagnosis of symptomatic adjacent segment disease was based on both newly developed clinical symptoms and radiological lesions at the disc levels adjacent to the lumbar laminoplasty. We evaluated the correlation between the incidence of symptomatic adjacent segment disease and the clinical parameters and radiological parameters. RESULTS: Eight patients (11%) showed deterioration in the lesions at the segment adjacent to laminoplasty. The disease-free survival rates by Kaplan-Meier survival analysis were 95.7% at 5 years, 63.1% at 10 years, and 42.1% at 13 years. The incidence of spondylolisthesis in the disease group was higher than that in the disease-free group. The preoperative range of motion of L1-L5 in the disease group was significantly higher than that in the disease-free group. In five patients in whom conservative treatment failed for adjacent segment disease, reoperations were performed and they were effective. CONCLUSIONS: It should be taken into account that adjacent segment disease occurs after expansive lumbar laminoplasty. Spondylolisthesis might be a risk factor for the disease. Although reoperation was effective, it is necessary to consider the patient's age and physical condition before choosing further surgical therapy.

Postoperative delirium in spine surgery.

BACKGROUND CONTEXT: Postoperative delirium is a great concern in the treatment of hip fracture. However, there have been no reports regarding the postoperative delirium in spine surgery. PURPOSE: To determine the incidence and risk factors for postoperative delirium in the patients who have had spine surgery. STUDY DESIGN/SETTING: The incidence and intraoperative risk factors of postoperative delirium were retrospectively examined in patients who had spine surgery during a 3-year period. PATIENT SAMPLE: Three hundred forty-one patients who underwent spine surgery from 2000 to 2002 were included. METHODS: The presence of delirium was determened by the Confusion Assessment Method. Laboratory data were checked preoperatively, at 1 day and 1 week postoperatively. The prognosis of postoperative delirium was evaluated. RESULTS: Postoperative delirium was found in 13 patients; all of them were in their 70's or 80's. The incidence of delirium was 12.5% in the patients over 70 years old. Hemoglobin and hematocrit levels at 1 day after surgery in the delirium group were significantly lower than those in the control group. One patient had persistent cognitive dysfunction after surgery. Two patients who developed postoperative delirium died during the follow-up period. CONCLUSION: Low concentrations of hemoglobin and hematocrit 1 day after surgery were risk factors for postoperative delirium. As delirium is thought to represent not only brain dysfunction, but also impaired general physical condition, careful observation is necessary for the management of patients with postoperative delirium.

Calcium phosphate cement-based vertebroplasty compared with conservative treatment for osteoporotic compression fractures: a matched case-control study.

OBJECT: Few studies have been conducted to compare vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures (OVCFs). To investigate the effects of calcium phosphate cement (CPC)-based vertebroplasty on relief of pain and augmentation of the fractured vertebral body (VB), the authors compared the results of CPC-assisted vertebroplasty with those of conservative treatment alone. METHODS: Two groups of patients were examined: the vertebroplasty group (30 consecutive patients with primary OVCF) and the control group (30 patients matched for age, sex, interval from injury to treatment, and grade of the posterior wall defects of the fractured VB). Outcome measures included the visual analog scale (VAS) score of back pain and analgesic requirements, and the radiographically documented rate of the VB kyphosis. The follow-up duration was more than 12 months (mean 17 months). The mean VAS score at 12 months after injury was 0.67 cm in the vertebroplasty group and 1.97 cm in the control group, and the mean improvement rates in the VAS scores were 91.6 and 73.6%, respectively (p < 0.0001). The mean duration of analgesic requirement was 8.3 days in the vertebroplasty group and 62.2 days in the control group (p = 0.0005). The mean kyphosis rate at 12 months after injury was 72.9% in the vertebroplasty group and 58% in the control group, and the mean recovery rate of kyphosis was +8.4 and -21%, respectively (p < 0.0001). CONCLUSIONS: The authors conclude that CPC-assisted vertebroplasty provides better clinical and radiological results than conservative treatment for primary OVCF.

Adjacent segment disease after anterior cervical interbody fusion / 中国矫形外科杂志

[Objective]The present study was undertaken to investigate the incidence of symptomatic adjacent segment disease after anterior cervical interbody fusion(ACIF),and to identify the factors which are related to the development of this disease.[Method]From 1981 to 1997,a total of 160 patients underwent anterior cervical in terbody fusion for intervertebral disc herniation and cervical spondylosis.A total of 112 patients were followed up clinically and radiologically for more than two years.Of them,74 were men and 38 were women,the average age at operation was 51 years(ranged,31~70 years).Of the 112 patients,66 had one,44 had two and 2 had three levels of fusion.Follow-up evaluation was primarily viaclinical visited.The post-operative course of any symptoms,the findings of neurological examination and serial follow-up radiographs were performed in all patients.The diagnosis of symptomatic adjacent segment disease was based on the presence of new radiculopathy or myelopathy symptoms referable to an adjacent level,and the presence of a compressive lesion at an adjacent level by magnetic resonance imaging or myelography.We evaluated the correlation between the incidence of symptomatic adjacent segment disease and the following clinical parameters(age at operation sex,number of the levels fused)and radiological parameters(preoperative cervical spine alignment,preoperative range of motion of C_(2~7) cervical spine,antero-posterior spinal canal diameter,preoperative existence of an adjacent segment degeneration on plain radiograph,myelography and magnetic resonance imaging(MRI).[Result]The average length of follow-up was 9.4 years(ranged,2 to 19 years).Symptomatic adjacent segment disease developed in 19 out of 112 patients(19%)followed.A Kaplan-Meier survival analysis was performed in order to follow the disease-free survival of the entire series of patients.The disease free survival rates were 89% at 5 years,84% at 10 years and 67% at 17 years.The incidences of indentation of dura matter on pre-operative myelography or disc protrusion on MRI at the adjacent level were significantly higher in disease cases(P=(0.0 087),(0.0 299),respectively;Chi-square test).Howerer,the other parameters did not show a statistically significant difference.There were 7 cases(37%)who had failure of non-operative treatment and additional operations were performed.[Conclusion]The incidence of symptomatic adjacent segment disease after ACIF was higher when pre-operative myelography or MRI revealed asymptomatic disc degeneration at that level regardless of the number of the level number fused,pre-operative alignment,spinal canal diameter of fusion alignment.

Diagnosis and modern surgical treatment of pyogenic osteomyelitis of the spine / 中国矫形外科杂志

[Objective]To explore the characteristics and management of pyogenic osteomyelitis of the spine.[Method]Thirty-nine patients with pyogenic osteomyelitis of the spine,who were treated by single-stage anterior debridement and interbody bone graft fusion,were included.The clinical presentations,laboratory,biological as well as radiological characteristics and surgical outcomes were investigated.[Result]The mean follow-up duration was 8.5 years,ranging from 2 to 17 years.All the patients had marked improvement in their back pain,17 of whom obtained complete recovery,the remaining 22 patients had occasional mild pain.Sensory deficit aggravated in 1 patient,the remaining 38 patients had marked improvement in the neurological function of the lower extremity.The recovery rate of clinical symptoms and signs ranged from 20% to 100%(averaged,75.6%).Bony fusion was obtained in all the patients in 4 months on average(ranged,2～6 months).ESR decreased from 73mm/h preoperatively to 29mm/h at 4 months after operation,while C reactive protein decreased to normal.There was no death and no other complication relating to opertion.Species of pathogen:culture positive in 19 cases(48.7%).Of these,S.aureus in 10 cases,et al.[Conclusion]The underlying diseases of patients were risk factors of pyogenic osteomyelitis of the spine,pathogens involved not only S.aureus but also other low virulent organisms.CRP was more sensitive than ESR or white cell counts,it may also be the parameter to evaluate outcomes of therapy.MRI has been shown to have the highest sensitivity,specificity and accuracy in the diagnosis of pyogenic osteomyelitis of the spine.Single-stage anterior debridement and interbody bone graft fusion are save and effective to treat pyogenic osteomyelitis of the spine.

Spinal stenosis due to ossified lumbar lesions.

OBJECT: Spinal stenosis due to lumbar ossified lesions is a rare pathological entity. The authors retrospectively evaluated the clinical features and surgical results associated with cases involving lumbar ossified lesion-induced stenosis. METHODS: Data obtained in 20 surgically treated patients with lumbar hyperostotic spinal stenosis were included. To evaluate the background of the disease, body mass index and general complications were assessed. Whole-spine radiological examination was conducted. The presence of ossification of the posterior longitudinal ligament or ossification of the ligamentum flavum was evaluated. Surgical results were classified according to the Japanese Orthopaedic Association (JOA) scale. In the patients in whom neurological deterioration was observed during follow up, the causes of deterioration were reviewed. Seven patients (35%) were obese and six patients (30%) suffered diabetes mellitus. Twelve patients harbored coexisting cervical and/or thoracic ossified lesions. The overall mean JOA score improved from 10.2 to a peak of 22.5; at last follow-up examination the mean JOA score was 20.9. In female and older patients with a long history of preoperative symptoms, a low preoperative JOA score, and other spinal lesions, recovery tended to be poorer. Recovery was poor in one patient, and neurological deterioration due to coexisting ossified spinal lesions occurred in another patient during the follow-up period. CONCLUSIONS: Because coexisting ossified lesions were frequently seen, whole-spine analysis is recommended. Early diagnosis and appropriate treatment are important to achieve a better surgical outcome.

Clinical and radiographic results of expansive lumbar laminoplasty in patients with spinal stenosis.

BACKGROUND: In 1981, we developed a technique of expansive lumbar laminoplasty to alleviate the problems of conventional laminectomy in the treatment of spinal stenosis. The purposes of this study were to assess the long-term outcome following expansive lumbar laminoplasty and to investigate the postoperative problems. METHODS: Fifty-four patients underwent expansive lumbar laminoplasty for the treatment of spinal stenosis. There were forty-three men and eleven women with a mean age of 52.6 years. The average length of follow-up was 5.5 years. Preoperatively, twenty-five patients had degenerative stenosis; thirteen, stenosis due to spondylolisthesis; twelve, combined stenosis (disc herniation and stenosis); and six, hyperostotic stenosis. (Two patients with hyperostotic stenosis and spondylolisthesis were included in both groups.) The clinical results were assessed with use of the Japanese Orthopaedic Association score, and the rate of recovery was calculated. Radiographic findings were analyzed on the basis of the cross-sectional area of the spinal canal, kyphosis, range of motion of the lumbar spine, and the rate of interlaminar fusion. RESULTS: The average recovery rate at the time of the last follow-up was 69.2% for patients with degenerative stenosis, 66.5% for patients with combined stenosis, 65.2% for those with hyperostotic stenosis, and 54.7% for those with spondylolisthesis. The factors resulting in a poor recovery were an older age and insufficient decompression of the lateral stenosis. During the follow-up period, the Japanese Orthopaedic Association score became worse for seven patients, six patients had lesions develop at the level adjacent to the laminoplasty, and five patients had spondylolisthesis develop. Interlaminar fusion was observed in twenty-two patients (41%). CONCLUSIONS: The satisfactory results of expansive lumbar laminoplasty were maintained at an average of 5.5 years after surgery. The best indications for the lumbar laminoplasty procedure were young and active patients with central spinal stenosis.

Calcium phosphate cement leakage after percutaneous vertebroplasty for osteoporotic vertebral fractures: risk factor analysis for cement leakage.

OBJECT: The purpose of this study was to analyze the risk factors for leakage of calcium phosphate cement (CPC) after vertebroplasty for osteoporotic vertebral fractures and to determine whether the vertebral body (VB) leakage caused any changes in the therapeutic benefits. METHODS: Between August 2000 and April 2002, the authors performed 65 CPC-assisted vertebroplasty procedures in 55 patients with thoracic or lumbar osteoporotic vertebral fractures. Back and low-back pain were evaluated using the visual analog scale and the duration of analgesic medication requirement. Factors related to CPC leakage and the postoperative outcome were analyzed. There was a small amount of VB CPC leakage in 23 cases. In 10 of 23 cases, leakage into the epidural space was found. Although VB CPC leakage was independently associated with high initial age, female sex, high bone mineral density (BMD), short injury-surgery interval, and injection via the unipedicular route in the logistic regression analysis, there was no factor associated with CPC leakage into the epidural space. Cement leakage into the epidural space reduced the immediate therapeutic effects on fracture-related pain (p = 0.0128). All patients in whom cement leaked into the epidural space had improved by the 2-week follow-up examination. CONCLUSIONS: Advanced initial age, female sex, high BMD, a short interval from injury to surgery, and injection via the unipedicular route may increase the incidence of CPC leakage. Cement leakage into the epidural space attenuated only the immediate therapeutic effects of CPC-assisted vertebroplasty.

Adjacent segment disease after anterior cervical interbody fusion.

BACKGROUND CONTEXT: There have been many follow-up studies on anterior interbody fusion for cervical nerve root and spinal cord compression, and excellent neurological outcomes have been reported. However, postoperative degenerative changes at adjacent discs may lead to the development of new radiculopathy or myelopathy. In the previous reports, the incidence of symptomatic adjacent segment disease has ranged from 7% to 15%. PURPOSE: The present study was undertaken to investigate the incidence of symptomatic adjacent segment disease after anterior cervical interbody fusion (ACIF) and to identify the factors that are related to the development of this disease. STUDY DESIGN/SETTING: This is a retrospective cohort study. PATIENT SAMPLE: A total of 112 patients were followed up clinically and radiologically for more than 2 years. OUTCOME MEASURES: Follow-up evaluation was primarily by means of clinical visits. The postoperative course of any symptoms, the findings of neurological examination and serial follow-up radiographs were performed in all patients. METHODS: The diagnosis of symptomatic adjacent segment disease was based on the presence of new radiculopathy or myelopathy symptoms referable to an adjacent level, and the presence of a compressive lesion at an adjacent level by magnetic resonance imaging or myelography. We evaluated the correlation between the incidence of symptomatic adjacent segment disease and the following clinical parameters (age at operation, sex, number of the levels fused) and radiological parameters (preoperative cervical spine alignment, preoperative range of motion of C2-C7 cervical spine, anteroposterior spinal canal diameter, preoperative existence of an adjacent segment degeneration on plain radiograph, myelography and magnetic resonance imaging [MRI]). RESULTS: Symptomatic adjacent segment disease developed in 19 of 112 patients (19%) followed. A Kaplan-Meier survival analysis was performed in order to follow the disease-free survival of the entire series of patients. The disease-free survival rates were 89% at 5 years, 84% at 10 years and 67% at 17 years. The incidences of indentation of dura matter on preoperative myelography or disc protrusion on MRI at the adjacent level were significantly higher in disease cases (p=.0087, .0299, respectively; chi-squared test). However, the other parameters did not show a statistically significant difference. There were seven cases (37%) who had failure of nonoperative treatment and additional operations were performed. CONCLUSIONS: The incidence of symptomatic adjacent segment disease after ACIF was higher when preoperative myelography or MRI revealed asymptomatic disc degeneration at that level regardless of the number of the levels fused, preoperative alignment, spinal canal diameter or fusion alignment.

Clinical and radiographic results of expansive lumbar laminoplasty in patients with spinal stenosis.

BACKGROUND: In 1981, we developed a technique of expansive lumbar laminoplasty to alleviate the problems of conventional laminectomy in the treatment of spinal stenosis. The purposes of this study were to assess the long-term outcome following expansive lumbar laminoplasty and to investigate the postoperative problems. METHODS: Fifty-four patients underwent expansive lumbar laminoplasty for the treatment of spinal stenosis. There were forty-three men and eleven women with a mean age of 52.6 years. The average length of follow-up was 5.5 years. Preoperatively, twenty-five patients had degenerative stenosis; thirteen, stenosis due to spondylolisthesis; twelve, combined stenosis (disc herniation and stenosis); and six, hyperostotic stenosis. (Two patients with hyperostotic stenosis and spondylolisthesis were included in both groups.) The clinical results were assessed with use of the Japanese Orthopaedic Association score, and the rate of recovery was calculated. Radiographic findings were analyzed on the basis of the cross-sectional area of the spinal canal, kyphosis, range of motion of the lumbar spine, and the rate of interlaminar fusion. RESULTS: The average recovery rate at the time of the last follow-up was 69.2% for patients with degenerative stenosis, 66.5% for patients with combined stenosis, 65.2% for those with hyperostotic stenosis, and 54.7% for those with spondylolisthesis. The factors resulting in a poor recovery were an older age and insufficient decompression of the lateral stenosis. During the follow-up period, the Japanese Orthopaedic Association score became worse for seven patients, six patients had lesions develop at the level adjacent to the laminoplasty, and five patients had spondylolisthesis develop. Interlaminar fusion was observed in twenty-two patients (41%). CONCLUSIONS: The satisfactory results of expansive lumbar laminoplasty were maintained at an average of 5.5 years after surgery. The best indications for the lumbar laminoplasty procedure were young and active patients with central spinal stenosis.

Clinical features of snowboarding injuries.

A retrospective study of 3102 injured snowboarders from 1992 to 1999 was undertaken using the medical records and questionnaires the patients had been asked to complete at the time of consultation. These cases represent all the injuries with medical treatment that occurred in five skiing and snowboarding resorts in the Nagano area. The total number of the injuries was 3243. The number of patients each year rapidly increased over the eight seasons. In descending order, the injuries were seen in the head and face, left upper extremity, spine, chest and abdomen, left lower extremity, right upper extremity, and right lower extremity. The number of head and face injuries was 829 (25%) followed by 768 (24%) left upper extremity injuries. With regard to the type of injury, fracture was the most frequent injury. There were 998 fractures, of which 625 were fractures of the upper extremity. Contusions were frequent on the head, face, chest, abdomen, and pelvis. Lacerations were frequent on the head and face. Sprains were frequent in the lower extremities, and dislocations were seen frequently in the upper extremities. The sharp increase in the number of patients was thought to reflect the increase in the population of snowboarders in Japan. The reason for the high concentration of injuries to the head and upper extremity is thought to derive from the characteristic riding form of snowboarding, with both legs fixed to one short, wide board. To decrease the injuries and to develop snowboarding as a safe and exciting sport, snowboarders, instructors, slope managers, and equipment manufacturers must comprehend the patterns of snowboarding injuries and cooperate to devise preventive measures.

A case of female premenopausal tophaceous gout requiring surgical management.

We report a case of tophaceous gout in a 32-year-old woman who had suffered from anorexia nervosa since the age of 15. She had been taking a diuretic, mainly furosemide, to lose weight since she was 18. She was referred for orthopedic surgery because of a tophus at her right metatarsophalangeal joint. Because of a discharging sinus associated with the tophaceous deposits, surgery was performed. Use of the diuretic was stopped after surgery and the serum uric acid concentration returned to normal. It was thought that long-term abuse of a diuretic induced the tophaceous gout in this premenopausal woman.

Upper thoracic myelopathy caused by vertebral collapse and subluxation in rheumatoid arthritis: report of two cases.

We report two cases of rheumatoid arthritis (RA) with upper thoracic myelopathy and a review of the literature. Clinical data of a 47-year-old woman (case 1) and a 54-year-old woman (case 2) are described. Case 1 showed a transverse-type myelopathy at the T2 segment level of the spinal cord and case 2 had the same type of myelopathy at the T4 segment level. Case 1 had anterior vertebral subluxation of C7 due to marked vertebral collapse and Case 2 had subluxation of T2 with vertebral destruction. These two patients had the mutilating type of RA with multilevel spontaneous fusion in the cervical spine. The lesions in the thoracic spine might be caused by the severe destructive inflammation that is characteristic in mutilating disease. The vertebral collapse might lead to subluxation of the upper thoracic vertebra, resulting in spinal cord compression. Upper thoracic subluxation might be caused by vertebral collapse due to RA and the increased motion as a compensation for decreased mobility caused by spontaneous fusion in the cervical spine.

Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis.

BACKGROUND CONTEXT: In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root compression is almost always seen on the concave side of the scoliosis, and L4 and L5 nerve roots are the most often involved. However, there are few reports on the relationship between nerve root compression and the pattern of scoliosis. PURPOSE: To investigate the factors that may contribute to radiculopathy in DLS and their association with the pattern of the scoliosis. STUDY DESIGN: Retrospective analysis. METHODS: Twenty-two consecutive patients with DLS with radiculopathy were examined. The symptomatic nerve roots were determined by pain distribution, neurological findings and nerve root infiltration using lidocaine. The compressive factors were diagnosed by magnetic resonance imaging or myelography, discography, computed tomography after myelography or discography and radiculography. The pattern of scoliosis was determined in plain radiographs. We evaluated the correlation between the affected nerve root and the compressive factors or the pattern of the scoliosis. RESULTS: The L3 root was affected in 23% of patients; L4 root in 68%, L5 root in 55% and S1 root in 18%. L3 and L4 roots were more compressed by foraminal or extraforaminal stenosis on the concave side of the curve, whereas L5 and S1 roots were commonly affected by lateral recess stenosis on the convex side. The Cobb angle and the lateral slip of the cases in which L3 or L4 root was affected were significantly larger than in cases in which L5 or S1 root was compressed. CONCLUSIONS: In the treatment of radiculopathy caused by DLS, it is important to bear in mind that L3 or L4 roots were more strongly compressed by foraminal or extraforaminal stenosis at the concave side of the curve, whereas L5 or S1 nerve roots were affected more by lateral recess stenosis at the convex side of the curve.

Pathomechanism of myelopathy and surgical results of laminoplasty in elderly patients with cervical spondylosis.

STUDY DESIGN: Clinical and radiologic analyses in elderly patients with cervical myelopathy. OBJECTIVE: To investigate the pathomechanism of cervical myelopathy and the surgical results of laminoplasty in elderly patients older than 70 years old. SUMMARY OF BACKGROUND DATA: To date, there have been no reports on the pathomechanism of cervical myelopathy in elderly patients. Further, the surgical results and postoperative complications of laminoplasty have not been fully evaluated in elderly patients. METHODS: Eighty-nine patients who underwent cervical laminoplasty were reviewed. The patients were divided into 2 groups according to the age at the time of operation (the elderly patient group: 20 patients who were older than 70 years old, and the control group: 69 patients who were younger than 69 years old). Pre- and postoperative neurologic status (the Japanese Orthopedic Association score) and postoperative complications were compared between the two groups. Radiologic features were also examined. RESULTS: There was no statistical difference in the recovery rate of Japanese Orthopedic Association score between the elderly patient group and the control group. Activities of daily living improved in the elderly patients. Several complications, such as delirium and worsening hypertension, were found in the elderly patient group. In the preoperative radiographs, the incidence of either retrolisthesis or anterolisthesis in the elderly patient group was significantly higher than that in the control group. CONCLUSIONS: Retrolisthesis and anterolisthesis are often the cause of myelopathy in elderly patients. Surgical decompression for cervical myelopathy was beneficial even in elderly patients older than 70 years old. Laminoplasty achieves stability of the cervical spine, and this procedure is reasonable for the treatment.

Minimum 10-year followup after en bloc cervical laminoplasty.

The long-term outcome (> 10 years) after cervical laminoplasty was assessed and the postoperative problems were clarified. One hundred thirty-three patients had laminoplasty between 1981 and 1989 for treatment of cervical myelopathy and 126 patients were available for the current study. The clinical results were evaluated using the Japanese Orthopaedic Association score. The radiologic findings were analyzed by postural anomalies and range of motion. The average preoperative score was 9.1 points, and the postoperative score improved to 13.7 points within a year. The Japanese Orthopaedic Association score and recovery rate were maintained at 13.4 points and 55.1% at the last followup. In 20 patients, the Japanese Orthopaedic Association score worsened during the followup. The causes of deterioration were axial spread of ossification of the posterior longitudinal ligament, other spinal lesions, cerebral infarction, and peripheral neuropathy. Postoperative cervical radiculopathy occurred in nine patients. Postoperative radiculopathy resolved in five patients, but remained in four patients. Kyphotic changes were observed in eight patients. The recovery rate in patients with kyphosis was poor. The postoperative range of motion decreased to 25.1% of preoperative range of motion. Sixty one percent of patients had a reduction of range of motion. Satisfactory results of cervical laminoplasty were maintained for more than 10 years after surgery; however, there were several postoperative problems, such as neurologic deterioration, postoperative radiculopathy, progression of kyphosis, and range of motion limitation.

Significance of bone formation markers in patients with ossification of the posterior longitudinal ligament of the spine.

STUDY DESIGN: Serum concentrations of bone formation markers were correlated with the type, location, and progression of ossification of the posterior longitudinal ligament. OBJECTIVE: To determine the relation between bone formation markers and ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: Few reports have correlated bone formation markers with ossification of the posterior longitudinal ligament. METHODS: In this study, 43 patients with cervical ossification of the posterior longitudinal ligament and myelopathy underwent laminoplasty. The patients were observed for more than 10 years, after which plain radiographs and tomograms of the cervical region were taken. The radiographs were selectively performed to address thoracic and lumbar ossification of the posterior longitudinal ligament. Serum concentrations of bone formation markers (intact osteocalcin, osteocalcin, carboxyterminal propeptide of human type 1 procollagen, and bone-specific alkaline phosphatase) were measured and correlated with these radiographic studies. RESULTS: A positive correlation was observed between intact osteocalcin, osteocalcin, and carboxyterminal propeptide of human type 1 procollagen in patients with combinations of cervical, thoracic, or lumbar ossification of the posterior longitudinal ligament. CONCLUSIONS: Serum concentrations of intact osteocalcin, osteocalcin, and carboxyterminal propeptide of human type 1 procollagen may reflect the activity of general ectopic bone formation in patients with ossification of the posterior longitudinal ligament.